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Companies Begin to Mandate Covid Vaccines for Employees

Some of the nation’s largest employers, for months reluctant to wade into the fraught issue of whether Covid-19 vaccinations should be mandatory for workers, have in recent days been compelled to act as infections have surged again.

On Tuesday, Tyson Foods told its 120,000 workers in offices, slaughterhouses and poultry plants across the country that they would need to be vaccinated by Nov. 1 as a “condition of employment.” And Microsoft, which employs roughly 100,000 people in the United States, said it would require proof of vaccination for all employees, vendors and guests to gain access to its offices.

Last week, Google said it would require employees who returned to the company’s offices to be vaccinated, while Disney announced a mandate for all salaried and nonunion hourly workers who work on site.

Other companies, including Walmart, the largest private employer in the United States, and Lyft and Uber, have taken a less forceful approach, mandating vaccines for white-collar workers but not for millions of frontline workers. Those moves essentially set up a divide between the employees who work in offices and employees who deal directly with the public and, collectively, have been more reluctant to get the shots.

different set of reasons that are not primarily political. They say many of their members are worried about potential health side effects or bristle at the idea of an employer’s interfering in what they regard as a personal health decision.

Marc Perrone, the president of the United Food and Commercial Workers union, representing 1.3 million employees in grocery chains such as Kroger and at large meatpacking plants, said he would not support employer mandates until the Food and Drug Administration gave full approval to the vaccine, which is being administered on an emergency basis.

“You can’t just say, ‘Accept the mandate or hit the door,’” Mr. Perrone said in an interview on Monday.

After Tyson announced its vaccine mandate on Tuesday, Mr. Perrone issued a statement that the union “will be meeting with Tyson in the coming weeks to discuss this vaccine mandate and to ensure that the rights of these workers are protected and this policy is fairly implemented.”

several meat plants became virus hot spots. Now, it is requiring its leadership team to be vaccinated by Sept. 24 and the rest of its office workers by Oct. 1. Frontline employees have until Nov. 1 to be fully inoculated, extra time the company is providing because there are “significantly more frontline team members than office workers who still need to be vaccinated,” a Tyson spokesman said.

Throughout the pandemic, companies have treaded carefully in carrying out public health measures while trying to avoid harm to their businesses.

Last year, when major retailers began requiring customers to wear masks, they quietly told their employees not to enforce the rule if a customer was adamant about not wearing one.

Companies like Walmart have tried a similarly tentative approach with vaccine requirements.

Walmart announced last week that it was requiring the roughly 17,000 workers in its Arkansas headquarters to be vaccinated but not those in stores and distribution centers, who make up the bulk of its 1.6 million U.S. employees.

In a statement, the retailer said the limited mandate would send a message to all workers that they should get vaccinated.

“We’re asking our leaders, which already have a higher vaccination rate, to make their example clear,” the company said. “We’re hoping that will influence even more of our frontline associates to become vaccinated.”

Lyft told their corporate employees last week that they would need to show proof they had been inoculated before returning to company offices.

Requiring vaccinations “is the most effective way to create a safe environment and give our team members peace of mind as we return to the office,” said Ashley Adams, a spokeswoman for Lyft.

But those mandates did not extend to the workers the companies contract with to drive millions of customers to and from their destinations. The drivers are being encouraged to be vaccinated, but neither Lyft or Uber has plans to require them.

Public health experts warn that limited mandates may reinforce the gaping divide between the nation’s high- and low-wage workers without furthering the public health goal of substantially increasing vaccination rates.

They also say it’s naïve to think that workers who resisted vaccines for ideological reasons would suddenly change their mind after seeing a company’s higher-paid executives receive the shots.

“Ultimately we want to ensure that they really have the broadest reach,” Dr. Kirsten Bibbins-Domingo, the vice dean for population health and health equity at the University of California, San Francisco, said of company directives. “Failing to do that, I think, will only cause others to be more suspicious of these types of mandates.”

Legally, companies are likely to be on solid ground if they mandate vaccines. Last year, the Equal Employment Opportunity Commission said employers could require immunization, though companies that do could still face lawsuits.

George W. Ingham, a partner at the law firm Hogan Lovells, said companies with mandates would potentially have to make difficult decisions.

“They are going to have to fire high performers and low performers who refuse vaccines,” he said. “They have to be consistent.” Reasons an employee could be exempted include religious beliefs or a disability, though the process of sorting those out on an individual basis promises to be an arduous one.

Companies may also have to contend with pushback from state governments. Ten states have passed legislation limiting the ability to require vaccines for students, employees or the public, according to the National Conference of State Legislatures.

Disney is among the few big companies pursuing a broad vaccine mandate for their work forces, even in the face of pushback from some employees.

In addition to mandating vaccines for nonunion workers who are on-site, Disney said all new hires — union and nonunion — would be required to be fully vaccinated before starting their jobs. Nonunion hourly workers include theme park guest-relations staff, in-park photographers, executive assistants and some seasonal theme park employees.

It was the furthest that Disney could go without a sign-off from the dozen unions that represent the bulk of its employees. Walt Disney World in Florida, for instance, has more than 65,000 workers; roughly 38,000 are union members.

Disney is now seeking union approval for the mandate both in Florida and in California, where tens of thousands of workers at the Disneyland Resort in Anaheim are unionized. Most of the leaders of Disney’s unions appear to be in favor of a mandate — as long as accommodations can be worked out for those refusing the vaccine for medical, religious or other acceptable reasons.

“Vaccinations are safe and effective and the best line of defense to protect workers, frontline or otherwise,” Eric Clinton, the president of UNITE HERE Local 362, which represents roughly 8,000 attraction workers and custodians at Disney World, said in a phone interview.

Mr. Clinton declined to comment on any pushback from his membership, but another union leader at Disney World, speaking on the condition of anonymity so he could speak candidly, said “a fair number” of his members were up in arms over Disney-mandated vaccinations, citing personal choice and fear of the vaccine.

“The company has probably done a calculation and decided that some people will unfortunately quit rather than protect themselves, and so be it,” the person said.

Lananh Nguyen contributed reporting.

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What It’s Like to Be in India’s Covid-19 Crisis

Infections are soaring. So are deaths. Whole cities are under lockdown. And the government seems powerless to help.

India is in the grip of a coronavirus crisis. Experts agree that the spread is probably even worse than the official statistics suggest. In many parts of the country, hospital beds, supplemental oxygen and other vital supplies are running short.

As Western countries roll out mass vaccination campaigns, only about 3 percent of India’s population is fully inoculated. Though conditions are slowly improving in New Delhi and Mumbai, the virus appears to be spreading largely unchecked through the rest of the country.

The New York Times asked readers in India to describe their lives in the midst of the pandemic with words and photos. They wrote about fear and loss, anxiety and boredom. Some wrote about their anger at the stumbling response by India’s government under Prime Minister Narendra Modi. But they also wrote about family and friends who have helped them cope, and efforts they have made to help neighbors and strangers alike.

“A lot of people my age have been helping people find resources like hospital beds, oxygen cylinders, medication, etc., through social media by verifying whatever leads are floating around on the internet and sending them to whoever needs them. I’ve been working with one such group. I realize that it is a necessary job in these times, but it’s also incredibly draining. It is the sign of a completely broken system that teenagers have to band together and work themselves to exhaustion trying to answer all these desperate pleas all over Twitter. And it’s getting harder to do by the day as things worsen because resources get exhausted very quickly. Most of the time we just end up calling a lot of numbers and get no response, and when we do it’s usually people saying there’s nothing they can do for us. It’s heartbreaking when people around are just suffering and dying and there’s so little you can do to help. We’re all terrified and burnt out and this is a very unsustainable system of getting people access to health care. You can’t leave it to the citizens to bear the brunt of a health care system that’s crumbling.” — Arunima Tiwari, New Delhi

“I miss spontaneity. I hate that I now have to plan everything out and even when I do, the plans feel like they can just disappear. I’m trying not to focus on what could have been. Instead, I’m determined to stay focused on what I can do. I have reactivated my long-dormant social media accounts to amplify what I can, and I now volunteer at a response center that offers assistance to Covid-positive patients. I don’t have a choice but to help because elected authorities have made it loud and clear that they aren’t going to.” — Anindita Nayak, Bangalore

“Life in Delhi at the moment feels like you’re having an out-of-body experience. It’s hard to imagine this is actually real and happening. Every social media feed, every WhatsApp group is full of requests from people looking for oxygen, hospital beds, critical lifesaving medicines. The worst part: There’s almost nothing you can do to help anyone immediately. It takes hours of verifying, calling, begging for help to actually find some solutions, if that even happens. By that time, you feel almost too scared to call back and find out if help is still needed for fear of hearing the inevitable — that the person has died without getting adequate care. Indians are dying not because of Covid but because they’re not receiving treatment and care.” — Shweta Bahri, Delhi

“Both my parents got Covid. I lost my mother yesterday. Father is on ventilator support. The reason I lost my mother is because she didn’t get treatment. I live in Bangalore, and there is no way you can get a bed in any hospital. The help line numbers never work. If they do, then they just take details or transfer your call with no help. Being completely helpless, I took my mother to a hospital that I’m not sure is even legitimate. They just wanted money from me. They did not have trained staff. Oxygen was always in short supply. I felt helpless that I could not take her anywhere. I knew that if I kept her there she would not survive. I had to bring my father there, and his condition deteriorated due to lack of oxygen. I managed to take him to a different hospital, but it was too late. Now he is on a ventilator.” — Paresh Patil, Bangalore

Rahul Patil died on May 17, Paresh Patil said, after this submission was received.

“It has been challenging, but I maintain a mood log throughout the day and encourage my family to do the same. I also post a mood meter on social media so people can reply with how they are feeling using an emoji and we can talk about it. I also help my parents with their medicines, food, oximeter and temperature readings. Since both have different sets of medications, it’s really important we keep a record of the medicines along with a chart of the vitals. My extended family has been very helpful during this time. They remain connected through calls and texts and remind us not to lose faith.” — Rachita Ramya, Delhi

“Since I have been going to work every day, I have not really experienced the lockdown in terms of staying inside. But it has been a very stressful year when it comes to working. When the lockdown lifted last year, people immediately rushed into the bank where I work. It has been very difficult and almost impossible here, in a rural part of India, to make people understand the importance of masks and social distancing.”

“The government has done little to make people aware of the situation. Also, the lockdowns initially were more of a television ratings stunt rather than a precautionary measure. A lot of workers in banks have died on duty, and some have been denied leave even when they were sick. The precautionary measures on paper are nowhere close to reality. In the past few months, we played dumb to something which we clearly saw coming.” — Shweta Beniwal, Kolar

“As I type this out, four doors lay ajar or wide open in my home. Three of us have now developed Covid symptoms. My old dad has been taking care of cooking, cleaning, medicating and sanitizing all day. My dad sleeps in fits through the day and night, interrupted by calls for food, tea, hoarse coughing, and groans of pain and frustration. How do I cope? Each night, as a 21-year-old, lying wide-awake — the weather is unbearably hot, and my fever rarely subsides — I make up positive scenarios in my mind. Getting a job and earning enough to secure my family’s well-being in this cruel dog-eat-dog world. Being more bold, less hesitant, in fighting people who didn’t see the warning signs of a corrupt, inept distribution of resources. Slapping each of those complacent idiots who voted into power a ruthless demagogue who wins elections by stoking fear and resentment but is a dud when it comes to long-term policymaking, tough decision-making and leadership.” — Harmandeep Khera, Chandigarh

Since sending his submission, Mr. Khera said, he and his family have recovered.

“Many friends have been infected, and we call each other every day to share a joke and to stay positive and make plans to meet in the future. Still frightening, but we are coping. I also try to help people overcome disinformation and keep telling people that most of us who are infected will recover. I ask people to avoid panic buying and seeking unvalidated cures. Since last year I have exercised regularly and continue to do so even while infected and isolated. I am also a pistol shooter for my state of Maharashtra, so mental conditioning has been an important part of my training. I meditate for 10 minutes each day to stay positive.” — Raj Khalid, Mumbai

“It is very frightening. Half of the people I know have been tested positive or have been previously infected. We haven’t stepped out of the house for the past two weeks, and it has taken a greater toll on our physical and mental health. The only rule is to avoid contact. If you want to keep your close ones safe, then you need to keep them away for a while. My mother is an essential worker, and I have seen her doing grocery shopping for many needy people who are quarantined. It’s something I’m proud of. In times like these, we need to hold on to humanity and have faith in whatever you believe in. Being an atheist, I have faith in science and myself.” — Akash Helia, Mumbai

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The Caribbean Conundrum: United by Tourists, Divided by Covid

Then, in March, Aruba teamed up with JetBlue, which offers about 40 weekly flights from the United States to the island, to debut CommonPass, the world’s first digital vaccine passport. Those with the digital pass may take a virtually supervised at-home PCR test within three days of departure, upload results and cut through immigration lines. United’s Aruba flights from Newark and Houston also use the pass, with plans for additional routes in the near future.

“We wanted to create a way to make it easier on travelers and more efficient for our air travel partners,” said Shensly Tromp, director of development and technology at Aruba Airport Authority N.V., “without compromising the safeguards we have in place around health and safety.”

Vaccination information will be added to CommonPass as early as June.

Before the pandemic, almost three-quarters of the island’s gross domestic product and nearly 85 percent of jobs had been rooted in tourism, according to W.T.T.C. analysis. Now, with tourism up 53 percent from February to March, Dangui Oduber, the minister of tourism, public health and sport, noted a “continual uptick” since Aruba’s dual CommonPass and vaccine rollouts.

Aruba too is a world leader in vaccinations. As of mid-May, almost 57,500 Arubans were at least partially inoculated, with the island optimistically reaching herd immunity this summer, Mr. Oduber said.

Vaccines

Even when Americans were shut out of most of the world, the borders to the U.S. Virgin Islands never closed. Lured there with slogans like “Reconnect with Paradise” and the chance for anyone to get vaccinated, even before many could get a shot back home, visitors have recently crowded the American territory’s beaches and restaurants.

Hotel occupancy rates in the U.S.V.I. are almost triple that of the region and seven times that of the Bahamas, according to recent analysis by STR, a global hospitality data and analytics company.

Visitors are required to get tested but not to quarantine. With tourists swarming, the U.S.V.I. prioritized hospitality workers early in its vaccine rollout. So, in February Sandy Colasacco, a nurse practitioner who runs the Island Health and Wellness Center, a nonprofit clinic serving many of St. John’s uninsured population, reached out to most restaurants and hotels there to schedule appointments.

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Taiwan Faces a Surge in New Covid-19 Infections

TAIPEI, Taiwan — Closed schools and restaurants offering takeout only. Lines around the block at testing sites. Politicians on television urging the public to stay calm.

If the scenes around Taiwan this week have a distinctly early pandemic feel, it is because the coronavirus is only now washing up on the island’s shores in force. A crush of new infections has brought a swift end to the Covid-free normality that residents had been enjoying for more than a year.

By shutting its borders early and requiring two-week quarantines of nearly everyone who arrives from overseas, Taiwan had been managing to keep life on the island mostly unfettered. But all that changed after enough infections slipped past those high walls to cause community outbreaks.

For most of the past week, the government has ordered residents to stay home whenever possible and to wear masks outdoors, though it has not declared a total lockdown. Local authorities are ramping up rapid testing, though some health experts worry that too few tests are being done to stay ahead of the virus’s spread.

1,290 Covid-19 cases and 12 deaths during the entire pandemic.

Adding to the concern: Only around 1 percent of the island’s 23.5 million residents have been vaccinated against the virus so far.

happily shielded from its worst ravages.

Eight months passed last year without a single case of community transmission until an infection in December snapped the streak. Even after that, local infections cropped up only sporadically for months.

Then the tide shifted — gradually, then suddenly.

On April 14, the government began allowing crew members for Taiwanese airlines to quarantine at home for just three days after arriving on long-haul flights, down from the previous requirement of five days.

more pilots and their family members were testing positive, as were employees at a quarantine hotel.

On May 10, a pilot who had been in the United States tested positive after completing his three-day quarantine, but not before he had visited a pub and a restaurant in Taipei.

ordered into rolling 14-day home quarantines. But it was probably too late. A cluster of infections began to emerge among workers and patrons at so-called hostess bars in Taipei’s Wanhua District.

By the end of the week, daily case numbers had soared into the triple digits.

So far, the search for new infections has been concentrated in the populous cities of Taipei and New Taipei, where more than 1,600 people can receive rapid testing each day. Hospitals are also providing slower testing services.

Dr. Chiang Kuan-yu, 37, a physician at Taipei City Hospital, went to Wanhua District on Monday to help run a testing site there. He said there had been big crowds over the weekend, when the case numbers first started to rise. Some people had to wait an extra day to get tested.

“Now there are more resources for testing, so we can keep up better,” Dr. Chiang said.

Chen Shih-chung, Taiwan’s health minister and head of its Central Epidemic Command Center, has urged those with no Covid-19 symptoms and no history of contact to not even come to testing sites, lest they become infected there.

“This only will slow down our search for possible spreaders,” Mr. Chen said in a news briefing. “Don’t go there thinking, ‘Oh, maybe I’m infected, maybe it’s best that I get tested.’ You absolutely must not come.”

early March, and it has since been gradually immunizing health workers and other priority groups. Officials say doses of the Moderna vaccine will arrive soon. Several Taiwanese companies are also developing vaccines.

Taiwanese authorities began working with domestic vaccine producers in January 2020, after the coronavirus’s genetic sequence was made available and before the Chinese city of Wuhan went into lockdown.

“Taiwan got started extremely early,” said Dr. Ho Mei-shang, a research fellow at the Institute of Biomedical Sciences at Academia Sinica in Taipei who was involved with the government’s vaccine efforts. “We said at the time, ‘Whatever the vaccine ends up being, we want make it ourselves as quickly as possible.’”

But Taiwan’s insistence on developing and producing its own immunizations may have made officials less quick to snap up overseas vaccines when those started becoming available, Dr. Ho said.

“And then,” she said, “by the beginning of this year, when the pandemic was so severe in so many countries, we just said we’ll wait a little.”

Even after the AstraZeneca vaccine first became available in Taiwan, the low case count meant many people felt no urgent need to get immunized.

Still, Dr. Ho said she was heartened to see how quickly people in Taiwan were adjusting to the new restrictions on daily life, even after such a carefree past year.

Recently, she went for a run at 10 p.m. and forgot to wear her mask at first. But she noticed that even at that hour, everyone else who was out walking and exercising was masked up.

“This is a state of affairs,” she said, “that really sets Taiwan apart.”

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What Do New Mask Rules Mean for Company Vaccine Mandates?

“I don’t know if it’ll solve it in the long run,” said Mr. Gigante of Proskauer Rose. “But I do think that’s what we’re talking to people about and talking to clients about.”

Requiring tests before an employee can come to work doesn’t fully protect other employees from contracting the disease. Tests vary in accuracy, and results refer only to the moment tests were administered. The more frequent the tests, the more informative they are. Mr. Gigante said he most commonly hears of companies mandating tests twice a week, though some situations, like a movie set or a courtroom, may require daily testing.

Some companies may not want to deal with considerations that come with such a program — like the cost, the need to figure out where and how to administer the tests, and the headache of keeping track of the results.

“Logistics and costs were making it less likely to be relied on by employers as an avenue, but as tests are becoming more available and less expensive, employers are looking at testing as a good layer of protection,” said David Schwartz, who runs the labor group at the law firm Skadden, Arps, Slate, Meagher & Flom.

Laura Godfrey in Saugatuck, Mich., is curious about the relationship between vaccinations and employee health care plans. “Companies have been focused on wellness to a determined level,” she writes. “So to ask for a vaccine seems reasonable.”

“It’s definitely something that’s on a lot of employers’ minds,” said Emily Zimmer, a partner who specializes in employee benefits at the law firm Troutman Pepper.

That’s particularly the case for companies with established wellness programs, she said. For example, if a company already rewards employees who receive annual flu shots, it would be easier to do the same for employees who receive the Covid-19 vaccine.

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Why the C.D.C. Changed Its Advice on Masks

Advice from federal health officials that fully vaccinated people could drop their masks in most settings came as a surprise to Americans, from state officials to scientific experts. Even the White House got less than a day’s notice from the Centers for Disease Control and Prevention, the press secretary, Jen Psaki, said at a news briefing on Friday.

“The C.D.C., the doctors and medical experts there, are the ones who determined what this guidance would be based on their own data, and what the timeline would be,” Ms. Psaki said. “That was not a decision directed by or made by the White House.”

For months, federal officials have vigorously warned that wearing masks and social distancing were necessary to contain the pandemic. So what changed?

Introducing the new recommendations on Thursday, Dr. Rochelle P. Walensky, the C.D.C. director, cited two recent scientific findings as significant factors: Few vaccinated people become infected with the virus, and transmission seems rarer still; and the vaccines appear to be effective against all known variants of the coronavirus.

There is no doubt at this point that the vaccines are powerful. On Friday, the C.D.C. released results from another large study showing that the vaccines made by Pfizer-BioNTech and Moderna are 94 percent effective in preventing symptomatic illness in those who were fully vaccinated, and 82 percent effective even in those only partly vaccinated.

“The science is quite clear on this,” said Zoë McLaren, a health policy expert at the University of Maryland, Baltimore County. Mounting evidence indicates that people who are vaccinated are highly unlikely to catch or transmit the virus, she noted.

The risk “is definitely not zero, but it’s clear that it’s very low,” she said.

One of the lingering concerns among scientists had been that even a vaccinated person might carry the virus — perhaps briefly, without symptoms — and spread it to others. But C.D.C. research, including the new study, has consistently found few infections among those who received the Pfizer-BioNTech and Moderna vaccines.

“This study, added to the many studies that preceded it, was pivotal to C.D.C. changing its recommendations for those who are fully vaccinated against Covid-19,” Dr. Walensky said in a statement on Friday.

Other recent studies confirm that people who are infected after vaccination carry too little virus to infect others, said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai.

“It’s really hard to even sequence the virus sometimes because there’s very little virus, and it’s there for a short period of time,” he said.

Still, most of the data has been gathered on the Pfizer-BioNTech and Moderna vaccines, Dr. Krammer cautioned. Because Johnson & Johnson’s vaccine was authorized later, there are fewer studies assessing its effectiveness.

In clinical trials, the Johnson & Johnson vaccine had 72 percent efficacy — lower than the figure for the Pfizer and Moderna vaccines. And effectiveness was measured in terms of moderate and severe disease, rather than mild disease.

“It’s a very good vaccine, and I’m sure it will save many, many, many lives,” Dr. Krammer said. “But we need more data on how well the J.&J. vaccine prevents infection, and how well it prevents transmission.”

Variants of the virus have been a particular worry for scientists. While Dr. Walensky cited evidence showing that the mRNA vaccines like those from Pfizer and Moderna are effective against the variants circulating in the United States, there is little data about variants and the Johnson & Johnson vaccine. And new variants are emerging constantly.

“I’m not at all saying that this is now a big problem,” Dr. Krammer said. But before lifting the masking requirements, “I might have waited a little bit longer to look at the numbers.”

In a statement on Friday, a C.D.C. spokesman said, “All of the authorized vaccines provide strong protection against serious illness, hospitalization, and death, and we are accumulating data that our authorized vaccines are effective against the variants that are circulating in this country.”

Fully immunized people are unlikely to get seriously ill, even if they are infected with the coronavirus. The risk of infection is greater for the people around them — unvaccinated children and adults, or vaccinated people who remain unprotected because of a medical condition or treatment.

C.D.C. officials said they weighed those factors and were confident in their assessment of the science. And the new advice has other salutary effects, rewarding fully immunized people by giving them permission to end their social isolation — and perhaps incentivizing others to opt for vaccination.

The new advice “signals that we really are on the final stretch here, and I think that’s a very good thing for people,” said Dr. Joshua Sharfstein, the vice dean for public health practice and community engagement at Johns Hopkins University Bloomberg School of Health.

“It’s unlikely that we’re going to have another huge surge in cases,” he added. “But will the final stretch last for weeks or months is still a question.”

The difficulty with the new recommendations, he and other experts said, is not so much the science underpinning them as their implementation.

Leaders at the state, city and county levels still have the authority to require masks even for vaccinated people, as the C.D.C. was quick to acknowledge on Thursday. After the agency’s announcement, some states instantly lifted mask mandates, while others said they would need more time to weigh the evidence.

But in states without mask mandates, the onus of checking vaccination status will fall on shopkeepers, restaurant workers, school officials and workplace managers.

“Without a means to verify vaccination, we will have to rely on an honor system,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.

The number of cases in the country is the lowest it has been since September, and many experts support lifting mask mandates in much of the country. But doing so will be riskier in places like Michigan, where there are more cases, and for people who are unprotected, including children under 12 and people with a weak immune systems, Dr. Rivers said.

“People who are unvaccinated should continue to wear masks in public indoors and avoid crowds,” she said.

In Nacogdoches, Texas, Dr. Ahammed Hashim fretted that only 36 percent of the population was immunized and the pace seemed to have stalled. And yet only one or two people in 10 in the local shops wore masks.

“I think the C.D.C. might send a wrong message saying that everything’s OK,” said Dr. Hashim, a pulmonologist. “It would feel much better if we had a 60 or 70 percent vaccination.”

The C.D.C.’s guidance is intended for fully vaccinated individuals, and should only be interpreted as such, Dr. Sharfstein cautioned. Nationwide, only 36 percent of the population is fully vaccinated.

“What we’re just seeing is a little bit of the distance between advice that is entirely appropriate for people who are vaccinated, and the reality that there are places that still are seeing viral transmission and a lot of people who aren’t vaccinated,” he said.

Individuals may make choices based on their perception of their own risks, but state and local leaders must decide what’s best for the community based on the rate of infections. “Those are two different things,” Dr. Sharfstein said. “And when they get conflated, that’s when people may make bad judgments about policy.”

The new guidelines should serve as a reminder to health officials to step up their outreach and investment to ensure that everyone has access to vaccines, Dr. McLaren said. Parents of children under 12 should continue to urge them to wear masks indoors.

The C.D.C.’s new policy shifts the onus onto the immunocompromised as well, to protect themselves from unmasked and unvaccinated people.

“When we make policy, we need to balance the needs and desires of everyone,” Dr. McLaren said. “We could keep masking forever, but there are benefits to getting back to a life that looks more normal.”

Health officials should emphasize that the situation may yet change, and official recommendations with it, she added: “We really need to practice being good at responding to changing situations.”

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Covid Pandemic Demands Air Quality Changes in the Workplace, Researchers Say

Clean water in 1842, food safety in 1906, a ban on lead-based paint in 1971. These sweeping public health reforms transformed not just our environment but expectations for what governments can do.

Now it’s time to do the same for indoor air quality, according to a group of 39 scientists. In a manifesto of sorts published on Thursday in the journal Science, the researchers called for a “paradigm shift” in how citizens and government officials think about the quality of the air we breathe indoors.

The timing of the scientists’ call to action coincides with the nation’s large-scale reopening as coronavirus cases steeply decline: Americans are anxiously facing a return to offices, schools, restaurants and theaters — exactly the type of crowded indoor spaces in which the coronavirus is thought to thrive.

There is little doubt now that the coronavirus can linger in the air indoors, floating far beyond the recommended six feet of distance, the experts declared. The accumulating research puts the onus on policymakers and building engineers to provide clean air in public buildings and to minimize the risk of respiratory infections, they said.

new workplace standards for air quality, but the scientists maintained that the remedies do not have to be onerous. Air quality in buildings can be improved with a few simple fixes, they said: adding filters to existing ventilation systems, using portable air cleaners and ultraviolet lights — or even just opening the windows where possible.

Dr. Morawska led a group of 239 scientists who last year called on the World Health Organization to acknowledge that the coronavirus can spread in tiny droplets, or aerosols, that drift through the air. The W.H.O. had insisted that the virus spreads only in larger, heavier droplets and by touching contaminated surfaces, contradicting its own 2014 rule to assume all new viruses are airborne.

The W.H.O. conceded on July 9 that transmission of the virus by aerosols could be responsible for “outbreaks of Covid-19 reported in some closed settings, such as restaurants, nightclubs, places of worship or places of work where people may be shouting, talking or singing,” but only at short range.

detailed 10 lines of evidence that support the importance of airborne transmission indoors.

On April 30, the W.H.O. inched forward and allowed that in poorly ventilated spaces, aerosols “may remain suspended in the air or travel farther than 1 meter (long-range).” The Centers for Disease Control and Prevention, which had also been slow to update its guidelines, recognized last week that the virus can be inhaled indoors, even when a person is more than six feet away from an infected individual.

“They have ended up in a much better, more scientifically defensible place,” said Linsey Marr, an expert in airborne viruses at Virginia Tech, and a signatory to the letter.

“It would be helpful if they were to undertake a public service messaging campaign to publicize this change more broadly,” especially in parts of the world where the virus is surging, she said. For example, in some East Asian countries, stacked toilet systems could transport the virus between floors of a multistory building, she noted.

More research is also needed on how the virus moves indoors. Researchers at the Department of Energy’s Pacific Northwest National Laboratory modeled the flow of aerosol-size particles after a person has had a five-minute coughing bout in one room of a three-room office with a central ventilation system. Clean outdoor air and air filters both cut down the flow of particles in that room, the scientists reported in April.

But rapid air exchanges — more than 12 in an hour — can propel particles into connected rooms, much as secondhand smoke can waft into lower levels or nearby rooms.

guidance for Covid does not require improvements to ventilation, except for health care settings.

“Ventilation is really built into the approach that OSHA takes to all airborne hazards,” said Peg Seminario, who served as director of occupational safety and health for the A.F.L.-C.I.O. from 1990 until her retirement in 2019. “With Covid being recognized as an airborne hazard, those approaches should apply.”

In January, President Biden directed OSHA to issue emergency temporary guidelines for Covid by March 15. But OSHA missed the deadline: Its draft is reportedly being reviewed by the White House’s regulatory office.

only during medical procedures known to produce aerosols, or if they have close contact with an infected patient. Those are the same guidelines the W.H.O. and the C.D.C. offered early in the pandemic. Face masks and plexiglass barriers would protect the rest, the association said in March in a statement to the House Committee on Education and Labor.

“They’re still stuck in the old paradigm, they have not accepted the fact that talking and coughing often generate more aerosols than do these so-called aerosol-generating procedures,” Dr. Marr said of the hospital group.

increase the risk, perhaps because they inhibit proper airflow in a room.

The improvements do not have to be expensive: In-room air filters are reasonably priced at less than 50 cents per square foot, although a shortage of supply has raised prices, said William Bahnfleth, professor of architectural engineering at Penn State University, and head of the Epidemic Task Force at Ashrae (the American Society of Heating, Refrigerating and Air-Conditioning Engineers), which sets standards for such devices. UV lights that are incorporated into a building’s ventilation system can cost up to roughly $1 per square foot; those installed room by room perform better but could be 10 times as expensive, he said.

If OSHA rules do change, demand could inspire innovation and slash prices. There is precedent to believe that may happen, according to David Michaels, a professor at George Washington University who served as OSHA director under President Barack Obama.

When OSHA moved to control exposure to a carcinogen called vinyl chloride, the building block of vinyl, the plastics industry warned it would threaten 2.1 million jobs. In fact, within months, companies “actually saved money and not a single job was lost,” Dr. Michaels recalled.

In any case, absent employees and health care costs can prove to be more costly than updates to ventilation systems, the experts said. Better ventilation will help thwart not just the coronavirus, but other respiratory viruses that cause influenza and common colds, as well as pollutants.

Before people realized the importance of clean water, cholera and other waterborne pathogens claimed millions of lives worldwide every year.

“We live with colds and flus and just accept them as a way of life,” Dr. Marr said. “Maybe we don’t really have to.”

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After the Pandemic, Will More People Wear Masks for Colds and Flu?

Once Americans return to crowded offices, schools, buses and trains, so too will their sneezes and sniffles.

Having been introduced to the idea of wearing masks to protect themselves and others, some Americans are now considering a behavior scarcely seen in the United States but long a fixture in other cultures: routinely wearing a mask when displaying symptoms of a common cold or the flu, even in a future in which Covid-19 isn’t a primary concern.

“I will still feel a responsibility to protect others from my illness when I have a cold or bronchitis or something along those lines,” said Gwydion Suilebhan, a writer and arts administrator in Washington who said he also plans to continue wearing masks in situations like flying on airplanes. “It’s a responsible part of being a human in a civil society to care for the people around you.”

Such routine use of masks has been common for decades in other countries, primarily in East Asia, as protection against allergies or pollution, or as a common courtesy to protect nearby people.

Meet the Press.”

Other leading American health officials, however, have not encouraged the behavior. The Centers for Disease Control and Prevention — which at the beginning of the pandemic advised against wearing masks, and only changed its guidance a couple of months later — does not advise people with flu symptoms to wear masks, and says they “may not effectively limit transmission in the community.”

That’s partly because there’s no tidy scientific consensus on the effect of masks on influenza virus transmission, according to experts who have studied it.

Nancy Leung, an epidemiologist at the University of Hong Kong, said that the science exploring possible links between masking and the emission or transmission of influenza viruses was nuanced — and that the nuances were often lost on the general public.

randomized controlled trials — the gold standard in scientific research — that masking reduced transmission of influenza viruses in a community.

There was some evidence from observational studies that masks reduced community transmission of influenza viruses, she added, but that research had a caveat: Observational studies cannot isolate masking from other possible factors, such as hand hygiene or social distancing.

“You can’t really decipher whether that observed reduction in transmission is due to face masks alone or not,” Dr. Leung said.

For similar reasons, the fact that the flu all but vanished in the United States during the coronavirus pandemic — and that many Americans anecdotally reported that they caught fewer colds than usual in 2020 — is not evidence alone that masks were responsible.

In East Asia, the historical use of masks is based on more than just medical research, and the steps that led each country to adopt them vary widely.

Please sneeze into your elbow, not your hand.)

Others pointed to institutional differences, including a history of anti-masking laws in the United States that were implemented during periods of social unrest in order to discourage violence.

New York State, for example, passed an anti-masking law in 1845 to prevent tenants from demanding land reform, according to research by Sharrona Pearl, a professor of medical ethics at Drexel University in Philadelphia. And from the 1920s to 1950s, several states passed similar laws in response to violence by the Ku Klux Klan.

Several East Asian scholars said in interviews that the region’s mask-wearing customs varied widely because people in each country had responded over the years to different epidemiological or environmental threats.

Jaehwan Hyun, a professor of history of Pusan National University in South Korea, said that ignoring the nuances could be dangerous.

seasonal dust storms that sweep into the country from Mongolia and northern China.

“Generally speaking, Koreans until recently believed that mask wearing was a sort of ‘Japanese practice,’ not ours,” he said.

In Hong Kong, where 299 people died during the SARS epidemic of 2002-3, the experience of universal masking against that coronavirus helped create a “cultural familiarity” with a practice that was also common during episodes of severe air pollution, Mr. De Kai said.

“It was a big reminder to people that masks are important not only to protect yourself from the pollution but also to avoid infecting those around you,” he said.

In Taiwan, SARS and recent air pollution were the two main factors that prompted people there to develop the habit of mask wearing, said Yeh Ming-Jui, a professor of public health at National Taiwan University in Taipei.

Professor Yeh said he believed mask wearing was not more widespread in the West because people there had no immediate memories of a severe pandemic — at least until now.

“The experience and health practices of past generations have been gradually forgotten,” he said.

Amy Chang Chien contributed reporting from Taipei.

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FDA Authorizes Pfizer-BioNTech Vaccine for Children 12 to 15

Vaccinating children is crucial to building up population levels of immunity and curtailing the spread of the coronavirus. Though children spread the virus less efficiently than adults do, they make up about 23 percent of the population.

Experts have said that the country is unlikely to reach the “herd immunity” threshold — the point at which virus transmission essentially stalls — but vaccinating children will be important for getting as close as possible.

Ty Dropic, 14, one of the trial participants, urged others his age to be vaccinated so they could build up widespread immunity and protect themselves. He had no side effects, leading him to suspect that he got the placebo. If that turns out to be the case, he plans to be immunized as soon as possible.

“I know it can be kind of scary, but it’s really not as bad as it seems,” he said. “If you do get Covid, it’ll be a lot worse than getting stuck with a needle for, like, two seconds.”

Ty’s three siblings, ages 8, 10 and 16, are also enrolled in vaccine trials for their age groups. Their mother, Dr. Amanda Dropic, a pediatrician in northern Kentucky, said that in her practice, most parents were eager to have their children vaccinated so they could regain some semblance of normalcy.

“The anxiety and depression that we’re seeing with kids, the social delays, has been tremendous,” she said.

Dr. Dropic said her children understood the risks and were willing to volunteer because they saw it as a civic duty. Every medicine available today came to be because “somebody was willing to go first,” she added.

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